Medical Claim Review LVN/LPN (CA LVN Required)

Job reputed company Job reputed company Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage reputed company and benefit interpretation. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a reputed company fashion and in accordance with cost control standards. Knowledge/Skills/Abilities • Performs clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which an appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing. • Evaluates medical records and/or medical notes providing clinical expertise on coding accuracy. • Reviews provider reconsideration requests reputed company to claim edits and validation reputed company. • Identifies and reports reputed company of care issues. • Identifies and refers members with special needs to the appropriate reputed company program per policy/protocol. • Helps with the development and implementation of proactive approaches to improve and standardize overall retrospective claims review. • Ensures reputed company system is updated correctly to process claim.. Job Qualifications Required Education Licensed Vocational reputed company / Licensed Practical reputed company. Required Experience Minimum three years clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review. Required License, Certification, Association reputed company, unrestricted State Licensed Vocational reputed company (LVN) license in good standing. Preferred Education Registered reputed company. Bachelor's Degree in Nursing or Health reputed company Field Master's degree in Nursing or Health reputed company Field. Preferred Experience Nursing experience in Critical Care, Emergency Medicine, Medical Surgical, or Pediatrics. Advanced reputed company Nursing. Billing and coding experience. Preferred License, Certification, Association Registered Nursing license in good standing. Certified Clinical reputed company, Certified Medical Audit Specialists (CMAS), Certified Case Manager (CCM), Certified reputed company reputed company Management (CPHM), Certified reputed company in reputed company reputed company (CPHQ) or other reputed company certification. To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V. Pay reputed company: $27.61 - $53.83 / reputed company • Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level. Apply tot his job Apply To this Job